Lee M S, Kim D H, Kim H, Lee H S, Kim C Y, Park T S, Yoo K Y, Park B J, Ahn Y O
Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.
Int J Epidemiol. 1998 Apr;27(2):316-9. doi: 10.1093/ije/27.2.316.
Primary liver cancer is an important health problem in Korea, where hepatitis B virus (HBV) infection is prevalent. The authors conducted a prospective cohort study to evaluate the protective effect of HBV vaccination against liver cancer in adults.
A total of 370,285 males aged > or = 30 comprised the study population. They were clinically free of liver diseases, and had not been vaccinated against HBV at enrolment. The results of HBV surface antigen (HBsAg) and antibody to HBsAg (anti-HBs) marker positivity and those of the vaccination programme which took place during 1985 were used for the construction of the cohort. About 5% (n = 18,914) were HBsAg positive, 78,094 were anti-HBs positive, and 273,277 were negative for both. Among the candidates for HBV vaccination (n = 273,277), 35,934 (13.2%) people had been vaccinated against HBV during 1985. Cases of liver cancer were ascertained by record linkage and from medical records covering 1986-1989. A multivariate log-linear model was used to test statistical significance and to estimate relative risks (RR).
The total follow-up period was 1,404,566 person-years, with an average of 3 years and 10 months. A total of 302 incident cases were ascertained. The overall incidence rate of liver cancer was 21.7 per 100,000 person-years. With reference to the incidence level among the unvaccinated and uninfected, the RR of primary liver cancer among the chronically infected and that of the unvaccinated and infected was 18.1 (95% CI: 14.2-22.9) and 0.34 (95% CI: 0.19-0.60), respectively. The RR among the vaccinated group was 0.58 (95% CI: 0.31-1.09).
This study suggested that artificial immunization through HBV vaccination, even in adulthood, reduces the risk of liver cancer. It might also offer a practicable means of primary prevention, especially in areas with hyperendemicity of HBV infection.
在乙型肝炎病毒（HBV）感染流行的韩国，原发性肝癌是一个重要的健康问题。作者进行了一项前瞻性队列研究，以评估成人接种HBV疫苗对肝癌的保护作用。
共有370285名年龄≥30岁的男性组成研究人群。他们临床上无肝脏疾病，入组时未接种过HBV疫苗。HBV表面抗原（HBsAg）和抗HBsAg抗体（抗-HBs）标志物阳性结果以及1985年期间的疫苗接种计划结果用于构建队列。约5%（n = 18914）为HBsAg阳性，78094人为抗-HBs阳性，273277人两者均为阴性。在HBV疫苗接种候选人（n = 273277）中，35934人（13.2%）在1985年期间接种了HBV疫苗。通过记录链接和1986 - 1989年的医疗记录确定肝癌病例。使用多变量对数线性模型检验统计学意义并估计相对风险（RR）。
总随访期为1404566人年，平均3年10个月。共确定302例新发病例。肝癌的总体发病率为每100000人年21.7例。参照未接种疫苗且未感染人群的发病率水平，慢性感染人群中原发性肝癌的RR为18.1（95%CI：14.2 - 22.9），未接种疫苗但感染人群的RR为分别为0.34（95%CI：0.19 - 0.60）。接种疫苗组的RR为0.58（95%CI：0.31 - 1.09）。
本研究表明，即使在成年期通过接种HBV疫苗进行人工免疫也可降低肝癌风险。它还可能提供一种可行的一级预防手段，尤其是在HBV感染高度流行的地区。
